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Safety Improvement

Projects

Information Webinar

February 2019

12:00-13:00 EST

Welcome

Chris Power

CEO CPSI

Maryanne D’Arpino

Senior Director CPSI

Today’s Speakers

Maryanne D’Arpino

Senior Director

CPSI

Carla Williams

Senior Program Manager

CPSI

Mike Cass

Senior Program Manager

CPSI

Tricia Swartz

Senior Program Manager

CPSI

Gina De Souza

Senior Program Manager

CPSI

Alexandru Titeu

Project Coordinator

CPSI

Jessica Kettles

Project Coordinator

CPSI

Dr. Julia Moore

Senior Director

Center for Implementation

Agenda

Topic Speaker Time

1) Opening Remarks Maryanne D’Arpino 12:00-12:05

2) What is involved Carla Williams 12:05-12:10

3) Quality Improvement/Knowledge

Translation

Julia Moore 12:10-12:15

4) Teamwork and Communication Tricia Swartz 12:15-12:25

5) Medication Safety Mike Cass 12:25-12:35

6) Enhanced Recovery Canada Carla Williams 12:35-12:45

7) Questions and Answers Moderated by Chris Thrall 12:45-13:00

CPSI Launches New Safety Improvement Projects

• Canadian Patient Safety Institute (CPSI) launching 3 new Safety Improvement Projects (SIPs) April 2019-Oct 2020

• Delivery by expert faculty and coaches with mentoring provided over 18 month period

• Participating teams attend one 2-day face-to-face learning session in spring 2019, virtual learning sessions throughout the 18 months and an in-person 2-day face-to-face closing congress in spring 2020, followed by a 6 month sustainability/measurement/spread period

• Cost: $5,000 per team of four, this includes flights and accommodation for face-to-face learning session, and closing congress. Additional members welcome to attend at an additional cost.

During the 18 month learning collaborative

What will your team do?

• Opportunity to test and implement evidence-informed

change ideas within your practice

setting/organization

Ultimate Goal of your team

• To improve patient safety using a quality

improvement, knowledge translation and

implementation science approach for implementing

change

Knowledge Translation

and Implementation

Science

Quality Improvement/Knowledge Translation (QI/KT) Integrated

Approach

Dr. Julia Moore (Center for Implementation)

Teamwork and

Communication-

TeamSTEPPS Canada®

Tricia Swartz,

Senior Program Manager, CPSI

Healthcare has changed...

Photo A retrieved from http://smallbusiness-solution.com/hekint/michael-reese-hospital-nurses-interns-and-residents/

Photo B retrieved from MVNA Healthcare

Do you struggle with…

Does your team

struggle with lack

of standardized

communication

processes and

incidents of

patient harm?

Does your team struggle with hierarchy, conflict and interpersonal issues?

Would your team benefit from tools that help unite team members,

create situational awareness and strengthen leadership skills?

Barriers to team performance

• Inconsistent team membership

• Lack of information sharing

• Lack of time

• Varying communication styles

• Conventional thinking

• Hierarchy

• Defensiveness

• Lack of coordination and

follow-up

• Misinterpretation of cues

• Lack of role clarity

• Distractions

• Conflict

• Fatigue

• Workload

TeamSTEPPS®

Team Strategies & Tools to Enhance

Performance and Patient Safety

• Based on 30+ years of research and evidence

• Evidence shows team training programs

improve attitudes, increase knowledge and

improve behavioural skills

(McEwan et al., 2017)

(Cochrane et al., 2017)

(Salas et al., 2008)

TeamSTEPPS® IS: International

…and translated in

over ten languages

TeamSTEPPS® is international

TeamSTEPPS Canada™

What makes us unique?

• Enhanced patient-focused content developed in partnership with PFPSC

• Inclusion and representation of multiple health sectors

• Use of simulation and game play throughout content delivery

• Support and connection – providing a TeamSTEPPS Canada community

• Canadian videos and teaching aids

• Canadian data sources and references

Our partners

What can we do to improve teamwork and communication?

What will your Teamwork and Communication safety improvement team do?• test and implement evidence-informed tools and resources including

communication, leadership, situation monitoring, and mutual support tools

Ultimate Goal of your team

• improve quality and safety, decrease patient harm, promote cross-professional collaboration, develop common goals, decrease workload issues, and improve staff and patient satisfaction using new approaches that facilitate teamwork and communication based on quality improvement, knowledge translation and implementation science

If you think this is for you and your team...

Download the expression of interest here!

Teamwork and Communicationwww.patientsafetyinstitute.ca/safetyprojects

For more information please contact:

Tricia Swartz, Senior Program Managerteamworkandcommunication@cpsi-icsp.ca

(705) 220-3696

Medication Safety at

Care Transitions

Mike Cass

Senior Program Manager, CPSI

Why focus on medication safety at transitions?

Despite best intentions of healthcare providers and the design of healthcare systems,

medications can cause patient safety incidents.

Results can impact health outcomes, length of stay, readmission rates, and costs to

healthcare system.

In 2014 CPSI and Institute for Safe Medication Practices Canada (ISMP) co-led national

Medication Safety Summit to address the issue. Resulted in development of action plans to

support improving communication about meds at transitions including:

1. Create and disseminate national medication safety checklist for patients and

families i.e. “5 Questions to Ask”

2. Rebrand “Medication Reconciliation” (MedRec) as one component of

medication safety and promote rebranded products and resources

Five Questions to Ask-Goals

For patients:

• Convey need for involvement in their own healthcare

• Understand their role in maintaining accurate & up-to-

date medication list

• Take initiative to share this information and request

that it is reviewed with them

For providers:

• Refresh awareness of importance of an accurate

and up-to-date medication record

• Engage with patients using language that

emphasizes their role in medication safety

• Encourage patients to maintain accurate and up-to-

date medication list and review it with them

What is known about Med Rec?

1. Medication reconciliation (Med Rec) is widely recommended to avoid unintentional discrepancies between patients’ medications across transitions in care.

2. Clinically significant unintentional discrepancies affect only a few patients.

3. Med Rec alone likely does not reduce post-discharge hospital utilization within 30 days but may if bundled with other interventions that improve discharge coordination.

4. Pharmacists play a major role in most successful interventions.

5. Commonly used criteria for selecting high-risk patients does not consistently improve the effect of Med Rec.

Janice L. Kwan, MD*; Lisha Lo, MPH*; Margaret Sampson, MLIS, PhD; and Kaveh G. Shojania, MD (2013)

http://scholar.google.ca/scholar_url?url=http%3A%2F%2Fannals.org%2Fdata%2Fjournals%2Faim%2F926462%2F0000605-201303051-00006.pdf&hl=en&sa=T&oi=ggp&ct=res&cd=0&d=841364018003712922&ei=vGEFXJ3FIoX3ygS9h62wCQ&scisig=AAGBfm0czkb-N7Zikjhr5ZLakg6GUp_9KA&nossl=1&ws=1920x911

Mt. Sinai Hospital, Toronto-Geriatric Pharmacist led medication review

and de-prescribing with population focus on Social Frailty

Inclusion Criteria

1. 65 years or older

2. Polypharmacy (4 or more medication classes)

3. Physical / Cognitive impairment

4. Social Frailty - no close family or friends

Change implementation and results

New evidence based practice changes included:

• Engaging hospital based retail pharmacy to dispense discharge

medications in collaboration with in-patient MD, Pharmacist

• Home visit/home meds check by community pharmacist

• Timed medications so that home care nurse or other is in the home

when medications are due

• Results -> Significantly Decreased 30-day readmission (to be

published)

What can we do to improve medication safety at transitions?

Evidence supports the need to do something differently to improve medication safety at care transitions.

What will your medication safety improvement team do?

• Opportunity to test and implement evidence-informed change ideas that incorporate Medication Review and De-prescribing among targeted high risk groups within your practice setting/organization

Ultimate Goal

• To improve medication safety at transitions of care in vulnerable populations, using quality improvement, knowledge translation and implementation science approaches and techniques.

If you think this is for you and your team...

Download the expression of interest here!

Medication Safety at Care Transitionswww.patientsafetyinstitute.ca/safetyprojects

For more information please contact:

Mike Cass, Senior Program Managermedsafety@cpsi-icsp.ca

(905) 407-1767

Enhanced Recovery

Canada

Carla Williams,

Senior Program Manager, CPSI

Why this project ?

❑ Determine what were new or emerging best practices in

surgical care/surgical care safety,

❑ Disseminate and implement.

Enhanced Recovery Canada

Program based on Enhanced Recovery After Surgery ERAS®

Goals:

• Improved patient experience

• Reduced length of stay

• Decreased complication rates

• Fewer hospital readmissions

Canadian Presence of Enhanced Recovery Programs

Economic Analysis Study

conducted economic analysis for Enhanced Recovery Pathways in

elective colorectal surgery

Demonstrated reductions in:

Emergency department visits

General Practitioner visits

Length of stay (statistically significant)

Return on Investment:

Every $1 invested in ERAS® would bring $3.8 in return (range $2.4-$5.1)

Thanh., Chuck A., Wasylak T., Lawrence J., Faris P., Ljungqvist O., Nelson G., Gramlich L. (2016). An economic evaluation of the

Enhanced Recovery After Surgery (ERAS) multi-site implementation program for colorectal surgery in Alberta. Canadian Journal of

Surgery 2016;59(6);415-421. https://canjsurg.ca/wp-content/uploads/2016/11/59-6-415.pdf

Economic Analysis Study

conducted economic analysis comparing an Enhanced Recovery

program to conventional management for elective colorectal surgery

Demonstrated reductions in:

Shorter hospitalization

Decreased resource utilization

Lower societal costs (productivity losses, caregiver burden)

Lee, L.A., Mata, J.S., Ghitulescu, G.M., Boutros, M.S., Carlebois, P.S., Stein, B.S., Liberman, A.S., Fried, G.S., Morin, N.S.,

Carli, F.S., Latimer, E.S., Feldman, L.S. (2015). Cost-effectiveness of enhanced recovery versus conventional perioperative

management for colorectal surgery. Annals of Surgery, 262(6), 1026-1033.

CPSI, along with partner organizations will:

Bundle evidence-informed guidelines to create Enhanced Recovery Canada

Clinical Pathways (Colorectal)

Facilitate dissemination of Clinical Pathways

Create networks and tools to support implementation of Clinical Pathways

ERC Safety Improvement Project

ERC Safety Improvement Project

✓ Clinical Pathways: Pre, intra and post op

✓ Physician Order Sets✓ Patient Engagement Resources✓ Data Collection and Measurement Guide

(based on ACS-NSQIP ERAS variables)

ERC Safety Improvement Project

✓ Clinical Pathways: Pre, intra and post op

✓ Physician Order Sets✓ Patient Engagement Resources✓ Data Collection and Measurement Guide

(based on ACS-NSQIP ERAS variables)

ERC Chair and Faculty LeadDr. Claude Laflamme MD FRCP(C) (Sunnybrook Health Science)ERC FacultyAlison Nelson, RN, MN (Alberta Health Services)Emily Pearsall, MSc (University of Toronto)Debbie Watson, RN, BScN, MN (McGill University Health Center)Erin Ballah PT, M.Sc., MBA (Eastern Health, Newfoundland)

What will your ERC Improvement team do?

• test and implement evidence-informed change ideas for colorectal

surgery.

Ultimate Goal

• to enhance recovery after surgery using: quality improvement,

knowledge translation and implementation science approaches for

implementing change related to the peri-operative period

What can we do to improve Colorectal surgical outcomes?

If you think this is for you and your team...

Download the expression of interest here!

Enhanced Recovery Canadawww.patientsafetyinstitute.ca/safetyprojects

For more information please contact:

Carla Williams, Senior Program Managererc@cpsi-icsp.ca

(709) 685-8254

Questions?

SafetyImprovementProjects@cpsi-icsp.ca

Next Steps

Download the Expression of Interest for the specific Safety

Improvement Project

• Teamwork and Communication

• Medication Safety at Care Transitions

• Enhanced Recovery Canada

• https://www.patientsafetyinstitute.ca/en/toolsResources/Safety-Improvement-

Projects/Pages/default.aspx

The deadline to submit applications by email is March 1, 2019

• SafetyImprovementProjects@cpsi-icsp.ca

Thank you!